complexity & change in environment, biomedicine & society

Developing theory about community-based participatory research IV

(completing a series of posts presenting an exploratory research proposal about community-based participatory research [CBPR] on health disparities [HD] from March 2010)

3. What is a suitable HD to address by a research team that emerges through engagement^5 workshops?

A project would not be genuine community-based participatory research if the P.I. dictated the research question at the outset [12]. I will, however, bring into the project a concern about a specific source of current and future health disparities, namely, trauma-induced stress among young veterans of recent armed conflicts (an issue opened up for me by a colleague and a student who now works on mutual support among vets around PTSD). The long-term health-related objectives would be not only to reduce the effects of such trauma but also to establish a process of development through young-adulthood of resilience and of capacity to contribute positively—if only modestly at first—to community initiatives that respond to ongoing, stress-inducing social changes.

4. How can we show if engagement^5 works?

In this project “works” means that the members of communities and concerned health researchers become more skilled and effective in contributing to the desired outcomes of collaboration with diverse participants. “Works” also includes the more specific process goal of building a research team, with a wider constituency supporting it, that has identified a specific source of health disparities that engages the skills and interest of the team members and is ready to tackle it. The approach to showing that engagement^5 works taken in this project is to develop what I term “embedded process evaluation,” in which one person contributes to the evaluation and improvement of the ongoing facilitated processes of the workshops while they are underway. The embedded process evaluator is not a facilitator or leader of the process, but someone who observes, reviews products, naggingly asks “so what?” about any outcomes along the way (including any formative evaluation the facilitator might conduct), and eventually prepares a document that shows external evaluators (or funders) how well the process achieved its stated goals [13]. This role could be part of good facilitation, but the embedded process evaluator is someone who: a) is not as busy during the workshop as the main facilitator(s) will be; b) can provide feedback to the main facilitator(s), but has no say in whether/how that is used; c) might not be present at all meetings; d) in their own eyes and in the eyes of external parties, is not captured by the goals of the specific group that they are embedded in.

[13] Such a role was taken by sociologist Denise Lach in an institutional cultural change initiative at Oregon State University, pers. comm.and McMurray, J. K. and D. Lach (2002). Practicing change (Final report to W.K. Kellogg Foundation and Oregon State University for InterACTION! : Food Systems Professions Education Initiative). Corvallis, OR, Oregon State University. This role has affinities to monitoring and real-time evaluation in humanitarian relief work, e.g., Herson, M. and J. Mitchell (2005). “Real-Time Evaluation: where does its value lie?” Humanitarian Exchange Magazine 32(December), but also with many other approaches to evaluation and facilitation.